415 - How should triage protocols for intensive care resources allocate pediatric resources? Results from a democratic deliberation during the COVID-19 pandemic

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 415
Publication Number: 415.106

Naomi Singh, Universite de Montreal Faculty of Medicine, saint-hubert, PQ, Canada; Nathalie Gaucher, CHU Sainte-Justine, Montreal, PQ, Canada; Claudia Lucrecia Calderon Ramirez, Université de Montréal, Laval, PQ, Canada; Marie-Eve Bouthillier, University of Montreal, Montréal, PQ, Canada; Karell Laporte, Universite de Montreal Faculty of Medicine, Montréal, PQ, Canada

Presenting Author(s)

Naomi Singh, Bachelor in Nursing, Masters in clinical ethics (in progress) (she/her/hers)

Pediatric emergency and adult emergency nurse
Université de Montreal Faculty of Medicine CHU Sainte-Justine Hôpital du Sacré-Coeur de Montréal
saint-hubert, Quebec, Canada

Background:

Since the beginning of the COVID-19 pandemic, an ethical consensus regarding how to allocate pediatric intensive care (PICU) resources (material, human) in the context of a pandemic which disproportionately affected adults has not been reached. Understanding local social values is essential to better inform the design and preparation of prioritization protocols.

Objective:

The objective of this study was to explore the general population’s perceptions and values on the use of PICU resources to treat adults during the COVID-19 pandemic in Canada.

Design/Methods:

A democratic deliberation was held from May to June 2022 with adults from Ontario (n=27) and Quebec (n=20), Canada (none worked in healthcare). Participants took part in two days of information sessions and deliberations, in English and French; consensus was not sought. Participants were asked: how should we allocate PICU resources while protecting the interests of children in the context of the COVID-19 pandemic? Participants completed self-reflective questionnaires and were divided into six groups. Group discussions were audio-recorded and transcribed. Thematic content analysis was conducted using NVivo software (QSR Intl., 2022). Transcripts and answers to the questionnaire were coded independently by two researchers (NS and NG).

Results:

Participants’ answers were categorised into two main themes. Theme 1: Children’s resources should be protected. Participants referred to the sanctity of a child’s life and to a child’s right to be protected, reporting personal experiences with a child’s illness, or reflecting on their role as caregiver. In this theme, children were believed to have better prognoses than adults and a long life to live; it was generally based on this premise that they were given priority to resources over adults. Theme 2: PICU resources should be included in allocation strategies when faced with a lack of resources, but only if children will continue to have access to PICU resources. In this case, participants endorsed flexible strategies that sought to maximise resource utilization and save the most lives. It was believed that PICU resources should be shared in case of a surplus or if these were not saturated. Overall, all participants, but one, believed children should receive intensive care when clinically required, and that they should not be excluded from accessing PICU resources.

Conclusion(s):

This study provides insight into how the general population in Canada assesses the ethical tension between maximising the use of intensive care resources and protecting the interests of children.